Tajima T
Department of Surgery, Tokai University School of Medicine, Isehara, Japan.
Nihon Geka Gakkai Zasshi. 2000 Dec;101(12):833-9.
At the end of the 19th century, surgical treatment of breast cancer was revolutionized by the introduction of the Halsted radical mastectomy. Haagensen, who studied under one of Halsted's students, further strengthened the foundations of the technique, and the Halsted operation became the standard radical breast cancer surgery worldwide. This may have been responsible for the persistence of this operation, particularly in Japan. Some Halstedian surgeons espoused the extended radical mastectomy or super-radical mastectomy. However, breast-conserving surgery is now becoming the most common technique. In the early 1970s breakthroughs in the understanding of the biology of breast cancer led to a new era of adjuvant therapy. Consequently current surgical management of breast cancer is no longer possible without considering other therapeutic modalities. Consistent with this change, it should be realized that the disease is no longer diagnosed at the same stage as it was at the time of Halsted. Although the ultimate patient outcome is not likely to be influenced solely by locoregional treatment, surgery will continue to be employed as the most effective treatment modality, and every effort should be made to prevent locoregional tumor spread.
19世纪末，哈尔斯特德根治性乳房切除术的引入彻底改变了乳腺癌的外科治疗方法。哈根森曾师从哈尔斯特德的一名学生，他进一步巩固了该技术的基础，哈尔斯特德手术成为全球标准的根治性乳腺癌手术。这可能是该手术持续存在的原因，尤其是在日本。一些信奉哈尔斯特德手术理念的外科医生支持扩大根治性乳房切除术或超根治性乳房切除术。然而，保乳手术如今正成为最常用的技术。20世纪70年代初，对乳腺癌生物学认识的突破开启了辅助治疗的新时代。因此，如今不考虑其他治疗方式就无法进行乳腺癌的外科治疗。与此变化相一致的是，应该认识到，现在疾病的诊断阶段与哈尔斯特德时代不同了。尽管最终患者的预后不太可能仅受局部区域治疗的影响，但手术仍将继续作为最有效的治疗方式，并且应尽一切努力防止局部区域肿瘤扩散。
